Liu Jingjing, Ye Lechi, Miao Gengyun, Rao Shengxiang, Zeng Mengsu, Liu Liheng
Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China.
Int J Surg. 2025 Mar 1;111(3):2495-2504. doi: 10.1097/JS9.0000000000002252.
Adopting an appropriate noninvasive radiological method is crucial for periodic surveillance of liver metastases in colorectal cancer (CRC) patients after surgery, which is closely related to clinical management and prognosis. This study aimed to prospectively enroll stage II-III CRC patients for the surveillance of liver metastases and compare the diagnostic performance of contrast-enhanced CT (CE-CT) and non-enhanced abbreviated MRI (NE-AMRI) during this process.
587 CRC patients undergoing radical resection of the primary tumor were evaluated by 1 to 3 rounds of surveillance tests, consisting of abdominal CE-CT and contrast-enhanced MRI (CE-MRI) within 7 days at 6-month intervals. Subsequently, images of NE-AMRI were extracted from the CE-MRI examination, and paired CE-CT and NE-AMRI analysis were performed. The lesion-based detection rates between two protocols were compared, and a subgroup analysis was performed in lesions with a size of ≤10 mm. The patient-based sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the areas under the curves (AUCs) of CE-CT and NE-AMRI in each round were evaluated. Finally, the relationship between the diagnostic accuracy of two protocols and characteristics of patients was explored.
The lesion-based detection rates of NE-AMRI in three rounds were all significantly higher than those of CE-CT ( P < 0.001, P < 0.001, P = 0.003, respectively). In the subgroup analysis of lesions ≤ 10 mm, NE-AMRI also performed better than CE-CT ( P < 0.001, P = 0.002, P = 0.005, respectively). The patient-based sensitivities, specificities, NPVs, and PPVs of NE-AMRI were higher than those of CE-CT in three rounds of surveillance. The AUCs for NE-AMRI were all significantly better than those for CE-CT in each round ( P = 0.015, P = 0.045, P = 0.009, respectively). Furthermore, patient BMI and fatty liver disease had impacts on the diagnostic accuracy of the CE-CT protocol, but not on the NE-AMRI protocol.
NE-AMRI may be a promising periodic surveillance tool for CRC patients after surgery to increase diagnostic accuracy of liver metastases, developing personalized clinical management and improving prognosis, simultaneously avoiding side effects associated with ionizing radiation and contrast agents.
采用合适的非侵入性放射学方法对于结直肠癌（CRC）患者术后肝转移的定期监测至关重要，这与临床管理和预后密切相关。本研究旨在前瞻性纳入II - III期CRC患者进行肝转移监测，并比较在此过程中对比增强CT（CE - CT）和非增强简化MRI（NE - AMRI）的诊断性能。
587例行原发性肿瘤根治性切除的CRC患者接受了1至3轮监测检查，包括在6个月间隔的7天内进行腹部CE - CT和对比增强MRI（CE - MRI）。随后，从CE - MRI检查中提取NE - AMRI图像，并进行CE - CT和NE - AMRI配对分析。比较两种方案基于病灶的检出率，并对大小≤10 mm的病灶进行亚组分析。评估每轮中基于患者的CE - CT和NE - AMRI的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、准确性以及曲线下面积（AUC）。最后，探讨两种方案的诊断准确性与患者特征之间的关系。
NE - AMRI三轮基于病灶的检出率均显著高于CE - CT（分别为P < 0.001、P < 0.001、P = 0.003）。在大小≤10 mm病灶的亚组分析中，NE - AMRI也优于CE - CT（分别为P < 0.001、P = 0.002、P = 0.005）。在三轮监测中，基于患者的NE - AMRI的敏感性、特异性、NPV和PPV均高于CE - CT。每轮中NE - AMRI的AUC均显著优于CE - CT（分别为P = 0.015、P = 0.045、P = 0.009）。此外，患者体重指数和脂肪肝对CE - CT方案的诊断准确性有影响，但对NE - AMRI方案无影响。
NE - AMRI可能是CRC患者术后一种有前景的定期监测工具，可提高肝转移的诊断准确性，制定个性化临床管理并改善预后，同时避免与电离辐射和造影剂相关的副作用。
